Children Young for Grade More Likely to Be Prescribed Stimulants for ADHD

A new study reported in the journal Pediatrics, the official journal of the American Academy of Pediatrics, revealed that the youngest children in any given grade are more likely to do poorly on standardized tests, and more likely to be prescribed stimulant medications for ADHD compared to older students at the same grade level. The study surveyed almost 12,000 Icelandic students between the ages of 9 and 12 (Iceland keeps comprehensive demographic records of its population and has an ADHD drug prescription rate roughly equal to that of the U.S.). Children in the youngest third of their class were 50% more likely than those in the oldest third to be prescribed stimulants between ages 7 and 14.

This news should alarm parents, educators, and physicians who have been labeling and drugging kids for ADHD. Because it suggests that a substantial group of kids who have been given this diagnosis, are in fact simply entering school too early, and need to be given some latitude in their behaviors and performance in the classroom, not a medical diagnosis.

I have been arguing for years that ADHD is largely a developmental issue (see my earlier post on this subject). In my book ADD/ADHD Alternatives in the Classroom, I cited research suggesting that the symptoms of hyperactivity and impulsivity associated with ADHD declines 50% approximately every five years. This means that if the prevalence rate of hyperactivity and impulsivity ADHD in childhood is 4%, the estimated rate in adult ADHD would be 0.8 % at age 20 and 0.05% at age 40. More recently, a study of brain development in children revealed that the brains of kids diagnosed with ADHD develop normally, but, significantly, three years later than typically developing children.

The problem is that our school systems don’t account for developmental rates among children and adolescents. With the intense push for academic achievement that has been central to the so-called “reforms” that have been taking place in the U.S., the focus has been on academic performance, regardless of the age or grade level. The bottom line: we are expecting too much from those children who mature later than average, or who enter school young for their age.

This study is just the tip of the iceberg. The truth is that we’re putting too much pressure on all our kids to achieve academically. The things we used to expect first graders to do, we’re now requiring at the kindergarten level, and so on, up the grade levels. This only exacerbates the situation of children who mature later or who enter school young for their age.

The implications of this new study suggests that we take a good hard look at our schooling practices, and institute reforms that are developmentally appropriate, not simply piling on of school work and course requirements (see my book The Best Schools for a look at how schools can be created that are sensitive to the developmental needs of each age group).

The study also should cause us to reevaluate our understanding of ADHD, and take into consideration developmental factors before labeling and medicating a child who is simply young for his age or for his grade level. As the lead researcher of the Pediatrics study advised: “Don’t jump to conclusions when deciding whether a child has A.D.H.D. It could be the maturity level.”

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